ORCID Profile
0000-0001-7106-4456
Current Organisations
Shanghai University of Engineering Science
,
University of South Australia
,
Neuroscience Research Australia
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Publisher: Informa UK Limited
Date: 16-05-2017
Publisher: Oxford University Press (OUP)
Date: 03-2012
DOI: 10.2522/PTJ.20110290
Abstract: Motor control exercises to improve control and coordination of trunk muscles and graded activity under the principles of cognitive-behavioral therapy are 2 commonly used exercise therapies, yet there is little evidence to support the use of one intervention over the other. The objective of this study was to compare the effectiveness of motor control exercises and graded activity for patients with chronic nonspecific low back pain. This study was a prospectively registered randomized controlled trial with outcome assessment and statistical analyses conducted blind to group. The study was conducted in primary care settings. The participants were 172 patients with chronic (& weeks) nonspecific low back pain. Patients were randomly assigned to receive either motor control exercises or graded activity. There was no attempt to subclassify patients to match them to a treatment. Patients in both groups received 14 sessions of in idualized, supervised exercise therapy. Primary outcomes were average pain over the previous week (numeric rating scale) and function (Patient-Specific Functional Scale) secondary outcomes were disability (24-item Roland-Morris Disability Questionnaire), global impression of change (Global Perceived Effect Scale), and quality of life (36-Item Short-Form Health Survey questionnaire [SF-36]). Outcome measures were collected at baseline and at 2, 6, and 12 months after intervention. A linear mixed models analysis showed that there were no significant differences between treatment groups at any of the time points for any of the outcomes studied. For ex le, the effect for pain at 2 months was 0.0 (−0.7 to 0.8). Clinicians could not be blinded to the interventions. The results of this study suggest that motor control exercises and graded activity have similar effects for patients with chronic nonspecific low back pain.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 09-2016
Abstract: Letter to the Editor-in-Chief of JOSPT as follows: "One More Cause of Failure to Validate a CPR: Overfitting" with Author's Response J Orthop Sports Phys Ther 2016 (9):811-812. doi:10.2519/jospt.2016.0202.
Publisher: Elsevier BV
Date: 02-2006
DOI: 10.1016/J.JMPT.2005.11.015
Abstract: Palpation is used most commonly to assess tissue stiffness despite its well-known deficiencies. As an improvement, a mechanical technique known as ultrasonic indentation has been proposed. The purpose of this study was to compare the accuracy of 3 ultrasonic indentation techniques in quantifying bone displacement in a specially constructed tissue simulator. Three ultrasonic indentation techniques were tested for their accuracy: a rigid, laboratory-based method (rigid), a less rigid system actuated by hand (assisted), and a totally free-hand system (handheld). Each indentation technique was applied on a tissue simulator, which consisted of a deformable phantom overlying a displaceable piston to simulate soft tissue overlying bone. Measures of piston (ie, bone) displacement obtained by each indentation technique were compared with a gold standard of piston displacement to determine the accuracy of each technique. Statistical tests were used to determine if differences between experimental and reference measures of piston displacement were significant. When indented, phantom deformation preceded piston displacement because of unequal stiffness between the two. The rigid and assisted indentation techniques showed the best accuracy for measuring simulated bone displacement. Differences in accuracy between the rigid and assisted techniques were insignificant. The accuracy of the handheld technique was significantly less than the rigid and assisted techniques. The clinical utility of assisted ultrasonic indentation should be explored given its accuracy and the excessive size, cost, and complexity of the rigid technique. The large error magnitude of the handheld technique may exclude it from clinical use now.
Publisher: John Wiley & Sons, Ltd
Date: 19-08-2013
Publisher: Frontiers Media SA
Date: 17-01-2020
Publisher: Oxford University Press (OUP)
Date: 22-09-2014
Publisher: Wiley
Date: 28-07-2016
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.JPAIN.2022.07.008
Abstract: Over the last decade, the content, delivery and media of pain education have been adjusted in line with scientific discovery in pain and educational sciences, and in line with consumer perspectives. This paper describes a decade-long process of exploring consumer perspectives on pain science education concepts to inform clinician-derived educational updates (undertaken by the authors). Data were collected as part of a quality audit via a series of online surveys in which consent (non-specific) was obtained from consumers for their data to be used in published research. Consumers who presented for care for a persistent pain condition and were treated with a pain science education informed approach were invited to provide anonymous feedback about their current health status and pain journey experience 6, 12 or 18 months after initial assessment. Two-hundred eighteen consumers reported improvement in health status at follow-up. Results of the surveys from 3 cohorts of consumers that reported improvement were used to generate iterative versions of 'Key Learning Statements'. Early iteration of these Key Learning Statements was used to inform the development of Target Concepts and associated community-targeted pain education resources for use in public health and health professional workforce capacity building initiatives. PERSPECTIVE: This paper reflects an explicit interest in the insights of people who have been challenged by persistent pain and then recovered, to improve pain care. Identifying pain science concepts that consumers valued learning provided valuable information to inform resources for clinical interactions and community-targeted pain education c aigns.
Publisher: Oxford University Press (OUP)
Date: 06-2010
DOI: 10.2522/PTJ.20090233
Abstract: Clinical prediction rules (CPRs) for treatment selection in musculoskeletal conditions have become increasingly popular. The purposes of this review are: (1) to critically appraise studies evaluating CPRs and (2) to consider the clinical utility and stage of development of each CPR. Pertinent databases were searched up to April 2009. Studies aiming to develop or evaluate a CPR for treatment response in musculoskeletal conditions were included. Two independent reviewers assessed eligibility and extracted methodological data, stage of development, and effect size information. Eighteen studies, evaluating 15 separate CPRs, were included. Fourteen CPRs were at the derivation stage, and all CPRs had been evaluated using a single-arm trial design, thus it is not possible to determine whether the CPRs identify prognosis (regardless of treatment) or specifically response to treatment. The CPR at the validation stage investigated spinal manipulative therapy (SMT) for low back pain and had been evaluated in 2 separate well-conducted randomized controlled trials. The first trial demonstrated a clinically meaningful effect of the SMT CPR the additional effect from SMT in patients “positive-on-the-rule” was 15 Oswestry disability units at week 1 and 9 units at week 4. The second trial showed that the CPR did not generalize to a different clinical setting, including a modified treatment. Due to differences in methods of reporting and journal publication restraints (eg, word count restrictions), some quality assessment items may have been completed in the included studies, but not captured in this review. There is, at present, little evidence that CPRs can be used to predict effects of treatment for musculoskeletal conditions. The principal problem is that most studies use designs that cannot differentiate between predictors of response to treatment and general predictors of outcome. Only 1 CPR has been evaluated within an RCT designed to predict response to treatment. Validation of these rules is imperative to allow clinical application.
Publisher: Springer Science and Business Media LLC
Date: 11-03-2015
DOI: 10.1007/S00221-015-4242-8
Abstract: Previous studies showed that self-localisation ability involves both vision and proprioception, integrated into a single percept, with the tendency to rely more heavily on visual than proprioceptive cues. Despite the increasing evidence for the importance of vision in localising the hands, the time course of the interaction between vision and proprioception during visual occlusion remains unclear. In particular, we investigated how the brain weighs visual and proprioceptive information in hand localisation over time when the visual cues do not reflect the real position of the hand. We tested three hypotheses: Self-localisations are less accurate when vision and proprioception are incongruent under the same conditions of incongruence, people first rely on vision and gradually revert to proprioception if vision is removed immediately prior to hand localisation, accuracy increases. Sixteen participants viewed a video of their hands, under three conditions each undertaken with eyes open or closed: Incongruent conditions (right hand movement seen: inward, right hand real movement: outward), Congruent conditions (movement seen congruent to real movement). The right hand was then hidden from view and participants performed a localisation task whereby a moving vertical arrow was stopped when aligned with the felt position of their middle finger. A second experiment used identical methodology, but with the direction of the arrow switched. Our data showed that, in the Incongruent conditions (both with eyes open and closed), participants perceived their right hand close to its last seen position. Over time, the perceived position of the hand shifted towards the physical position. Closing the eyes before the localisation task increased the accuracy in the Incongruent condition. Crucially, Experiment 2 confirmed the findings and showed that the direction of arrow movement had no effect on hand localisation. Our hypotheses were supported: When vision and proprioception were incongruent, participants were less accurate and initially relied on vision and then proprioception over time. When vision was removed, this shift occurred more quickly. Our findings are relevant in understanding the normal and pathological processes underpinning self-localisation.
Publisher: Springer Science and Business Media LLC
Date: 14-03-2019
DOI: 10.1007/S00221-019-05512-3
Abstract: Left/right judgement (LRJ) tasks involve determining the laterality of presented hand or feet images. Allocentric images (third-person perspective 3PP) take longer to identify than egocentric images (first-person perspective 1PP), supporting that implicit motor imagery (IMI)-mentally manoeuvring one's body to match the shown posture-is used. While numerous cognitive processes are involved during LRJs, it remains unclear whether features of the in idual (e.g., visual exposure, experience, task-dependent use) influence the type of recognition strategy used during LRJs (IMI versus non-IMI). To investigate whether an in idual's routine visual exposure to hands/feet in 3PP disrupts the typical perspective-reaction time (RT) relationship in LRJs, hand therapists, podiatrists, and healthy controls completed online LRJ tasks of hand and feet images. A group-specific reduction in RT for only allocentric images would represent a switch to non-IMI strategies. The results show that routine visual exposure to feet in 3PP (podiatrists) results in quicker RTs only for allocentric images of feet, suggesting a switch from IMI to non-IMI (e.g., visual object-based recognition) strategies. In contrast, routine visual exposure to hands in 3PP (hand therapists) does not alter RT for allocentric images, suggesting maintenance of IMI. However, hand therapists have quicker RTs (vs other groups) for egocentric hand images, supporting enhanced sensorimotor processing for the hand, consistent with task-dependent use (precise hand use). Higher accuracy in health professionals (vs control) on both tasks supports enhanced body schema. Combined, this suggests that 3PP visual exposure to body parts and task-dependent use contribute to LRJ performance/recognition strategy.
Publisher: Wiley
Date: 07-2022
DOI: 10.1002/EJP.1992
Abstract: Negative experiences of needle procedures in childhood can lead to medical avoidance and vaccine hesitancy into adulthood. We evaluated the feasibility of two new interventions provided by clinical nurses to reduce the negative impact of vaccinations: ided attention (DA) and positive memory reframing (PMR). Children (8–12 years) were randomized into four groups: usual care (UC), DA, PMR or combined (DA + PMR). To evaluate feasibility, we undertook in‐depth analysis of video‐recorded interventions, nurse experiences (phone interviews) and child arent memory recall of interventions (phone interviews at 2 weeks post‐vaccination). Key clinical outcomes included child and parent ratings of needle‐related pain intensity and fear assessed at baseline, immediately post‐vaccination and 2 weeks post‐vaccination (recalled). A total of 54 child–parent dyads were screened, with 41 included (10/group, except PMR [ n = 11]). The interventions were not always completed as intended: 10%–22% of participants received complete interventions and two had adverse events related to protocol breach. Preliminary within‐group analyses showed no effects on child arent pain ratings. However, children in DA + PMR had reduced recalled fear ( p = 0.008), and PMR ( p = 0.025) and DA + PMR ( p = 0.003) had reduced fear of future needles. Parent ratings of child fear were also reduced immediately post‐vaccination for UC ( p = 0.035) and PMR ( p = 0.035). The interventions were feasible, although enhanced nurse training is required to improve fidelity. Preliminary clinical results appear promising, particularly for reducing needle‐related fear. Protocol registration: Protocol number ACTRN12618000687291 at ANZCTR.org.au Two new nurse‐led interventions to reduce negative impacts of vaccinations in children, ided attention and positive memory reframing, were feasible and may reduce needle‐related fear. Nurses were able to deliver the interventions in various environments including non‐clinical settings (schools). These interventions have potential to facilitate broader dissemination of vaccinations for children in a manner that minimizes distress.
Publisher: BMJ
Date: 16-09-2021
Publisher: Springer Science and Business Media LLC
Date: 31-12-2011
Publisher: Elsevier BV
Date: 10-2023
Publisher: MDPI AG
Date: 09-12-2020
DOI: 10.3390/IJMS21249378
Abstract: Nitrogen fixation in soybean consumes a tremendous amount of energy, leading to substantial differences in energy metabolism and mitochondrial activities between nodules and uninoculated roots. While C-to-U RNA editing and intron splicing of mitochondrial transcripts are common in plant species, their roles in relation to nodule functions are still elusive. In this study, we performed RNA-seq to compare transcript profiles and RNA editing of mitochondrial genes in soybean nodules and roots. A total of 631 RNA editing sites were identified on mitochondrial transcripts, with 12% or 74 sites differentially edited among the transcripts isolated from nodules, stripped roots, and uninoculated roots. Eight out of these 74 differentially edited sites are located on the matR transcript, of which the degrees of RNA editing were the highest in the nodule s le. The degree of mitochondrial intron splicing was also examined. The splicing efficiencies of several introns in nodules and stripped roots were higher than in uninoculated roots. These include nad1 introns 2/3/4, nad4 intron 3, nad5 introns 2/3, cox2 intron 1, and ccmFc intron 1. A greater splicing efficiency of nad4 intron 1, a higher NAD4 protein abundance, and a reduction in supercomplex I + III2 were also observed in nodules, although the causal relationship between these observations requires further investigation.
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.JPAIN.2012.09.007
Abstract: Graded motor imagery (GMI) is becoming increasingly used in the treatment of chronic pain conditions. The objective of this systematic review was to synthesize all evidence concerning the effects of GMI and its constituent components on chronic pain. Systematic searches were conducted in 10 electronic databases. All randomized controlled trials (RCTs) of GMI, left/right judgment training, motor imagery, and mirror therapy used as a treatment for chronic pain were included. Methodological quality was assessed using the Cochrane risk of bias tool. Six RCTs met our inclusion criteria, and the methodological quality was generally low. No effect was seen for left/right judgment training, and conflicting results were found for motor imagery used as stand-alone techniques, but positive effects were observed for both mirror therapy and GMI. A meta-analysis of GMI versus usual physiotherapy care favored GMI in reducing pain (2 studies, n = 63 effect size, 1.06 [95% confidence interval, .41, 1.71] heterogeneity, I(2) = 15%). Our results suggest that GMI and mirror therapy alone may be effective, although this conclusion is based on limited evidence. Further rigorous studies are needed to investigate the effects of GMI and its components on a wider chronic pain population. This systematic review synthesizes the evidence for GMI and its constituent components on chronic pain. This review may assist clinicians in making evidence-based decisions on managing patients with chronic pain conditions.
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.JPAIN.2013.04.001
Abstract: That complex regional pain syndrome (CRPS) is associated with functional reorganization in the primary somatosensory cortex (S1) is widely accepted and seldom questioned. Despite more than a decade of research, there has been no systematic review of the CRPS literature concerning the changes in S1 function, and therefore the extent of these changes is unclear. Here we conduct a systematic review and meta-analysis to quantify the spatial and temporal aspects of S1 function in CRPS. A comprehensive search strategy identified functional neuroimaging studies of S1 in CRPS. We adhered to a rigorous systematic review protocol when extracting data and appraising risk of bias. Outcomes were grouped into spatial representation activation levels, including disinhibition peak latency of activation and glucose metabolism. Meta-analysis was conducted where possible. Fifteen studies were included, all investigating upper-extremity CRPS. In patients with CRPS, the S1 spatial representation of the affected hand is smaller than that of the unaffected hand and that of non-CRPS controls however, this evidence comes from only a few studies. There is no difference in activation, disinhibition, or latency of peripherally evoked S1 responses in CRPS. The risk of bias was high across studies, mainly from unclear s ling methods and unblinded analysis of outcomes. The evidence for a difference in function of the primary somatosensory cortex in CRPS compared with controls is clouded by high risk of bias and conflicting results, but reduced representation size seems consistent.
Publisher: Springer Science and Business Media LLC
Date: 21-01-2021
DOI: 10.1186/S12891-021-03944-Z
Abstract: There is evidence that people with persistent shoulder pain exhibit findings consistent with the presence of sensorimotor dysfunction. Sensorimotor impairments can manifest in a variety of ways, and further developing our understanding of sensorimotor dysfunction in shoulder pain may improve current models of care. The Fremantle Back Awareness Questionnaire (FreBAQ) has been developed to assess disturbed body perception specific to the back. The purpose of the present study was to develop a shoulder-specific self-perception questionnaire and evaluate the questionnaire in people with persistent shoulder pain. The Fremantle Shoulder Awareness Questionnaire (FreSHAQ-J) was developed by modifying the FreBAQ. One hundred and twelve consecutive people with persistent shoulder pain completed the FreSHAQ-J. Thirty participants completed the FreSHAQ-J again two-weeks later to assess test-retest reliability. Rasch analysis was used to assess the psychometric properties of the FreSHAQ-J. Associations between FreSHAQ-J total score and clinical status was explored using correlational analysis. The FreSHAQ-J has acceptable category order, unidimensionality, no misfitting items, and excellent test-retest reliability. The FreSHAQ-J was moderately correlated with disability and pain catastrophization. The FreSHAQ-J fits the Rasch measurement model well and is suitable for use with people with shoulder pain. Given the relationship between the FreSHAQ-J score and clinical status, change in body perception may be worth assessing when managing patients with shoulder pain.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.PHYSIO.2016.04.001
Abstract: Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine the perceptions and experiences of physiotherapy students regarding CPRs, and whether they are learning about CPRs on clinical placement. Cross-sectional survey using a paper-based questionnaire. Final year pre-professional physiotherapy students (n=371, response rate 77%) from five universities across five states of Australia. Sixty percent of respondents had not heard of CPRs, and a further 19% had not clinically used CPRs. Only 21% reported using CPRs, and of these nearly three-quarters were rarely, if ever, learning about CPRs in the clinical setting. However most of those who used CPRs (78%) believed CPRs assisted in the development of clinical reasoning skills and none (0%) was opposed to the teaching of CPRs to students. The CPRs most commonly recognised and used by students were those for determining the need for an X-ray following injuries to the ankle and foot (67%), and for identifying deep venous thrombosis (63%). The large majority of students in this s le knew little, if anything, about CPRs and few had learned about, experienced or practiced them on clinical placement. However, students who were aware of CPRs found them helpful for their clinical reasoning and were in favour of learning more about them.
Publisher: Informa UK Limited
Date: 24-08-2016
DOI: 10.1080/13803395.2016.1203869
Abstract: Somatic hypervigilance describes a clinical presentation in which people report more, and more intense, bodily sensations than is usual. Most explanations of somatic hypervigilance implicate altered information processing, but strong empirical data are lacking. Attention and working memory are critical for information processing, and we aimed to evaluate brain activity during attention/working memory tasks in people with and without somatic hypervigilance. Data from 173 people with somatic hypervigilance and 173 controls matched for age, gender, handedness, and years of education were analyzed. Event-related potential (ERP) data, extracted from the continuous electroencephalograph recordings obtained during performance of the Auditory Oddball task, and the Two In A Row (TIAR) task, for N1, P2, N2, and P3, were used in the analysis. Between-group differences for P3 litude and N2 litude and latency were assessed with two-tailed independent t tests. Between-group differences for N1 and P2 litude and latency were assessed using mixed, repeated measures analyses of variance (ANOVAs) with group and Group × Site factors. Linear regression analysis investigated the relationship between anxiety and depression and any outcomes of significance. People with somatic hypervigilance showed smaller P3 litudes-Auditory Oddball task: t(285) = 2.32, 95% confidence interval, CI [3.48, 4.47], p = .026, d = 0.27 Two-In-A-Row (TIAR) task: t(334) = 2.23, 95% CI [2.20 3.95], p = .021, d = 0.24-than case-matched controls. N2 litude was also smaller in people with somatic hypervigilance-TIAR task: t(318) = 2.58, 95% CI [0.33, 2.47], p = .010, d = 0.29-than in case-matched controls. Neither depression nor anxiety was significantly associated with any outcome. People with somatic hypervigilance demonstrated an event-related potential response to attention/working memory tasks that is consistent with altered information processing.
Publisher: Future Medicine Ltd
Date: 05-2013
DOI: 10.2217/PMT.13.11
Abstract: SUMMARY Current clinical practice guidelines advocate a model of diagnostic triage for back pain, underpinned by the biopsychosocial paradigm. However, limitations of this clinical model have become apparent: it can be difficult to classify patients into the diagnostic triage categories patients with ‘nonspecific back pain‘ are clearly not a homogenous group and mean effects of treatments based on this approach are small. In this article, it is proposed that the biological domain of the biopsychosocial model needs to be reconceptualized using a neurobiological mechanism-based approach. Recent evidence about nociceptive and neuropathic contributors to back pain is outlined in the context of maladaptive neuroplastic changes of the somatosensory system. Implications for clinical practice and research are discussed.
Publisher: JMIR Publications Inc.
Date: 25-11-2020
Abstract: hronic low back pain (CLBP) is a global health problem associated with an increasing burden on in iduals, health care systems, and society. Common treatments for people with CLBP produce, on average, small short-term improvements in pain and function compared with minimal care. The RESOLVE trial randomly allocated 276 people with CLBP to a new complex treatment strategy, pain education integrated with graded sensorimotor precision training (RESOLVE), or a sham control. The RESOLVE treatment was developed within a theoretical framework to target possible treatment mechanisms associated with CLBP development and persistence. his protocol describes the planned evaluation of these proposed treatment mechanisms. Improved understanding of the mechanisms underpinning the RESOLVE treatment may guide its refinement and implementation. e will use causal mediation analysis to evaluate the proposed treatment mechanisms, including pain self-efficacy, back beliefs, pain catastrophizing, kinesiophobia, back perception, tactile acuity, and movement coordination. The primary outcomes are pain intensity and function at 18 weeks following allocation. Data were collected blind to allocation and hypotheses at baseline (mediators, outcomes, confounders), end of treatment (mediators), and at 18 weeks following allocation (outcomes). We will test the robustness of our findings by conducting planned sensitivity analyses. thical approval was granted by the University of New South Wales Human Research Ethics Committee (HC15357). A total of 276 participants have been recruited from primary care practices and the community in Sydney, Australia. he RESOLVE treatment constitutes a new paradigm for CLBP management with potentially wide-reaching implications. This mechanistic evaluation will provide evidence for the hypothesized treatment mechanisms and help explain why the treatment strategy did or did not have an effect on patient-reported outcomes. These results will help guide the treatment refinement and implementation. ustralian and New Zealand Clinical Trials Registry ACTRN12615000610538 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619& isReview=true ERR1-10.2196/26053
Publisher: BMJ
Date: 07-2020
DOI: 10.1136/BMJOPEN-2019-036542
Abstract: Epidemiological studies indicate an inverse association between nut consumption and body mass index (BMI). However, clinical trials evaluating the effects of nut consumption compared with a nut-free diet on adiposity have reported mixed findings with some studies reporting greater weight loss and others reporting no weight change. This paper describes the rationale and detailed protocol for a randomised controlled trial assessing whether the inclusion of almonds or carbohydrate-rich snacks in an otherwise nut-free energy-restricted diet will promote weight loss during 3 months of energy restriction and limit weight regain during 6 months of weight maintenance. One hundred and thirty-four adults aged 25–65 years with a BMI of 27.5–34.9 kg/m 2 will be recruited and randomly allocated to either the almond-enriched diet (AED) (15% energy from almonds) or a nut-free control diet (NFD) (15% energy from carbohydrate-rich snack foods). Study snack foods will be provided. Weight loss will be achieved through a 30% energy restriction over 3 months, and weight maintenance will be encouraged for 6 months by increasing overall energy intake by ~120–180 kcal/day (~500-750kJ/day) as required. Food will be self-selected, based on recommendations from the study dietitian. Body composition, resting energy expenditure, total daily energy expenditure (via doubly labelled water), physical activity, appetite regulation, cardiometabolic health, gut microbiome, liver health, inflammatory factors, eating behaviours, mood and personality, functional mobility and pain, quality of life and sleep patterns will be measured throughout the 9-month trial. The effects of intervention on the outcome measures over time will be analysed using random effects mixed models, with treatment (AED or NFD) and time (baseline, 3 months and 9 months) being the between and within factors, respectively in the analysis. Ethics approval was obtained from the University of South Australia Human Research Ethics Committee (201436). Results from this trial will be disseminated through publication in peer-reviewed journals, national and international presentations. Australian New Zealand Clinical Trials Registry (ACTRN12618001861246).
Publisher: Springer Science and Business Media LLC
Date: 29-08-2017
DOI: 10.1038/S41598-017-09429-1
Abstract: Does feeling back stiffness actually reflect having a stiff back? This research interrogates the long-held question of what informs our subjective experiences of bodily state. We propose a new hypothesis: feelings of back stiffness are a protective perceptual construct, rather than reflecting biomechanical properties of the back. This has far-reaching implications for treatment of pain/stiffness but also for our understanding of bodily feelings. Over three experiments, we challenge the prevailing view by showing that feeling stiff does not relate to objective spinal measures of stiffness and objective back stiffness does not differ between those who report feeling stiff and those who do not. Rather, those who report feeling stiff exhibit self-protective responses: they significantly overestimate force applied to their spine, yet are better at detecting changes in this force than those who do not report feeling stiff. This perceptual error can be manipulated: providing auditory input in synchrony to forces applied to the spine modulates prediction accuracy in both groups, without altering actual stiffness, demonstrating that feeling stiff is a multisensory perceptual inference consistent with protection. Together, this presents a compelling argument against the prevailing view that feeling stiff is an isomorphic marker of the biomechanical characteristics of the back.
Publisher: Informa UK Limited
Date: 03-07-2022
DOI: 10.1080/00207144.2022.2105147
Abstract: Chronic low back pain (CLBP) is a debilitating and burdensome condition, and new treatment strategies are needed. This study aimed to evaluate (1) the feasibility of undertaking a controlled clinical trial investigating a novel intervention for people with CLBP: hypnotically reinforced pain science education, and (2) the acceptability of the intervention as rated by participants.
Publisher: Oxford University Press (OUP)
Date: 06-2010
Publisher: Oxford University Press (OUP)
Date: 09-05-2013
DOI: 10.1093/RHEUMATOLOGY/KET139
Abstract: To determine whether tactile acuity is disrupted in people with knee OA and to determine whether tactile acuity, a clinical signature of primary sensory cortex representation, is related to motor imagery performance (MIP evaluates working body schema) and pain. Experiment 1: two-point discrimination (TPD) threshold at the knee was compared between 20 participants with painful knee OA, 20 participants with arm pain and 20 healthy controls. Experiment 2: TPD threshold, MIP (left/right judgements of body parts) and usual pain were assessed in 20 people with painful knee OA, 17 people with back pain and 38 healthy controls (20 knee TPD 18 back TPD). People with painful knee OA had larger TPD thresholds than those with arm pain and healthy controls (P < 0.05). TPD and MIP were not related in people with knee OA (P = 0.88) but were related in people with back pain and in healthy controls (P 0.15 for all). In painful knee OA, tactile acuity at the knee is decreased, implying disrupted representation of the knee in primary sensory cortex. That TPD and MIP were unrelated in knee OA, but related in back pain, suggests that the relationship between them may vary between chronic pain conditions. That pain was not related to TPD threshold nor MIP suggests against the idea that disrupted cortical representations contribute to the pain of either condition.
Publisher: Frontiers Media SA
Date: 03-11-2023
DOI: 10.3389/FRVIR.2020.564664
Abstract: Many adults are physically inactive. While the reasons are complex, inactivity is, in part, influenced by the presence of negative feelings and low enjoyment during exercise. While virtual reality (VR) has been proposed as a way to improve engagement with exercise (e.g., choosing to undertake exercise), how VR is currently used to influence experiences during exercise is largely unknown. Here we aimed to summarize the existing literature evaluating the use of VR to influence motivation, affect, enjoyment, and engagement during exercise. A Population (clinical, and healthy), Concept (the extent and nature of research about VR in exercise, including underpinning theories), and Context (any setting, demographic, social context) framework was used. A systematic search of Medline, Scopus, Embase, PsycINFO, and Google Scholar was completed by two independent reviewers. Of 970 studies identified, 25 unique studies were included ( n = 994 participants), with most (68%) evaluating VR influences on motivation, affect, enjoyment, and engagement during exercise in healthy populations ( n = 8 studies evaluating clinical populations). Two VR strategies were prominent – the use of immersion and the use of virtual avatars and agents/trainers. All studies but one used virtual agents/trainers, suggesting that we know little about the influence of virtual avatars on experiences during exercise. Generally, highly immersive VR had more beneficial effects than low immersive VR or exercise without VR. The interaction between VR strategy and the specific exercise outcome appeared important (e.g., virtual avatars/agents were more influential in positively changing motivation and engagement during exercise, whereas immersion more positively influenced enjoyment during exercise). Presently, the knowledge base is insufficient to provide definitive recommendations for use of specific VR strategies to target specific exercise outcomes, particularly given the numerous null findings. Regardless, these preliminary findings support the idea that VR may influence experiences during exercise via multiple mechanistic pathways. Understanding these underlying mechanisms may be important to heighten effects targeted to specific exercise outcomes during exercise. Future research requires purposeful integration of exercise-relevant theories into VR investigation, and careful consideration of VR definitions (including delineation between virtual avatars and virtual agents), software possibilities, and nuanced extension to clinical populations.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.CPR.2014.08.003
Abstract: A widely held belief within the clinical community is that chronic pain is associated with cognitive impairment, despite the absence of a definitive systematic review or meta-analysis on the topic. The current systematic review and meta-analysis aimed to establish the current evidence concerning the difference in executive function between people with chronic pain and healthy controls. Six databases were searched for citations related to executive function and chronic pain from inception to June 24, 2013. Two reviewers independently assessed studies for eligibility and extracted relevant data according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty five studies were included in the review and twenty two studies in the meta-analysis. A small to moderate impairment in executive function performance was found in people with chronic pain across cognitive components, although all studies had a high risk of bias. The current evidence suggests impairment of executive function in people with chronic pain, however, important caveats exist. First, executive function involves many cognitive components and there is no standard test for it. Second, moderators of executive function, such as medication and sleep, were seldom controlled for in studies of executive function performance.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2016
Publisher: Springer Science and Business Media LLC
Date: 24-10-2016
DOI: 10.1007/S00221-016-4782-6
Abstract: When vision and proprioception are rendered incongruent during a hand localisation task, vision is initially weighted more than proprioception in determining location, and proprioception gains more weighting over time. However, it is not known whether, under these incongruency conditions, particular areas of space are also weighted more heavily than others, nor whether explicit knowledge of the sensory incongruence (i.e. disconfirming the perceived location of the hand) modulates the effect. Here, we hypothesised that both non-informative inputs coming from one side of space and explicit knowledge of sensory incongruence would modulate perceived location of the limb. Specifically, we expected spatial weighting to shift hand localisation towards the weighted area of space, and we expected greater weighting of proprioceptive input once perceived location was demonstrated to be inaccurate. We manipulated spatial weighting using an established auditory cueing paradigm (Experiment 1, n = 18) and sensory incongruence using the 'disappearing hand trick' (Experiment 2, n = 9). Our first hypothesis was not supported-spatial weighting did not modulate hand localisation. Our second hypothesis was only partially supported-disconfirmation of hand position did lead to more accurate localisations, even if participants were still unaware of their hand position. This raised the possibility that rather than disconfirmation, a simple movement of the hand in view could update the sensory-motor system, by immediately increasing the weighting of proprioceptive input relative to visual input. This third hypothesis was then confirmed (Experiment 3, n = 9). These results suggest that hand localisation is robust in the face of differential weighting of space, but open to modulation in a modality-specific manner, when one sense (vision) is rendered inaccurate.
Publisher: Public Library of Science (PLoS)
Date: 29-09-2023
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.KNEE.2019.02.011
Abstract: There is increasing evidence that motor imagery performance (MIP) is impaired in conditions that have a component of movement dysfunction. However, MIP has not been investigated in people with chronic anterior cruciate ligament (ACL) deficiency who experience limited disability and function at high levels. This study had three objectives: (1) to assess implicit MIP in in iduals with a chronic ACL deficient (ACLD) knee compared with healthy controls (i.e., intact anterior cruciate ligament) (2) to determine if the location of ACL deficiency affects MIP (dominant versus non-dominant leg) and (3) to determine if impairment in MIP is specific to the side (injured versus non-injured) of ACL deficiency. Forty-five participants with chronic ACLD knee and 44 healthy controls completed a left/right judgement task of pictured knees using the "Recognise" app to evaluate implicit MIP. Accuracy and reaction time of judgements were compared between groups. Additionally, within the chronic ACLD knee group, we made comparisons between the dominant ACLD knee and non-dominant ACLD knee subgroups and between the injured knee and the non-injured knee of the ACLD group. There were no differences in implicit MIP between the ACLD knee and the control group, the non-injured knee versus injured knee of the ACLD knee group, or the dominant ACLD knee versus non-dominant ACLD knee subgroups. Implicit MIP is not disrupted in high functioning in iduals with chronic ACLD knee.
Publisher: PeerJ
Date: 03-05-2021
DOI: 10.7717/PEERJ.11156
Abstract: Complex Regional Pain Syndrome (CRPS) is characterised by pain, autonomic, sensory and motor abnormalities. It is associated with changes in the primary somatosensory cortex (S1 representation), reductions in tactile sensitivity (tested by two-point discrimination), and alterations in perceived hand size or shape (hand perception). The frequent co-occurrence of these three phenomena has led to the assumption that S1 changes underlie tactile sensitivity and perceptual disturbances. However, studies underpinning such a presumed relationship use tactile sensitivity paradigms that involve the processing of both non-spatial and spatial cues. Here, we used a task that evaluates anisotropy (i.e., orientation-dependency a feature of peripheral and S1 representation) to interrogate spatial processing of tactile input in CRPS and its relation to hand perception. People with upper limb CRPS ( n = 14) and controls with ( n = 15) or without pain ( n = 19) judged tactile distances between stimuli-pairs applied across and along the back of either hand to provide measures of tactile anisotropy. Hand perception was evaluated using a visual scaling task and questionnaires. Data were analysed with generalised estimating equations. Contrary to our hypotheses, tactile anisotropy was bilaterally preserved in CRPS, and the magnitude of anisotropic perception bias was comparable between groups. Hand perception was distorted in CRPS but not related to the magnitude of anisotropy or bias. Our results suggest against impairments in spatial processing of tactile input, and by implication S1 representation, as the cause of distorted hand perception in CRPS. Further work is warranted to elucidate the mechanisms of somatosensory dysfunction and distorted hand perception in CRPS.
Publisher: Wiley
Date: 28-10-2019
DOI: 10.1111/TPJ.14500
Abstract: We report reference-quality genome assemblies and annotations for two accessions of soybean (Glycine max) and for one accession of Glycine soja, the closest wild relative of G. max. The G. max assemblies provided are for widely used US cultivars: the northern line Williams 82 (Wm82) and the southern line Lee. The Wm82 assembly improves the prior published assembly, and the Lee and G. soja assemblies are new for these accessions. Comparisons among the three accessions show generally high structural conservation, but nucleotide difference of 1.7 single-nucleotide polymorphisms (snps) per kb between Wm82 and Lee, and 4.7 snps per kb between these lines and G. soja. snp distributions and comparisons with genotypes of the Lee and Wm82 parents highlight patterns of introgression and haplotype structure. Comparisons against the US germplasm collection show placement of the sequenced accessions relative to global soybean ersity. Analysis of a pan-gene collection shows generally high conservation, with variation occurring primarily in genomically clustered gene families. We found approximately 40-42 inversions per chromosome between either Lee or Wm82v4 and G. soja, and approximately 32 inversions per chromosome between Wm82 and Lee. We also investigated five domestication loci. For each locus, we found two different alleles with functional differences between G. soja and the two domesticated accessions. The genome assemblies for multiple cultivated accessions and for the closest wild ancestor of soybean provides a valuable set of resources for identifying causal variants that underlie traits for the domestication and improvement of soybean, serving as a basis for future research and crop improvement efforts for this important crop species.
Publisher: Elsevier BV
Date: 06-2021
DOI: 10.1016/J.JPAIN.2021.01.004
Abstract: We tested the hypotheses that rendering sensory input about hand location imprecise increases a classically conditioned pain expectancy effect, increases generalization of the effect to novel locations and reduces extinction of the effect. Forty healthy volunteers performed movements with their right hand along predefined paths. Each path passed through 2 locations that were defined as either i) the conditioned stimulus (CS+ paired with a painful unconditioned stimulus), or ii) unpaired (CS-). During acquisition phase, participants watched their hand as they moved it. Participants were randomly allocated to an Imprecise group, for whom visual feedback of the hand was offset 30 to 50 mm from its true location, or a Precise group, for whom vision was not disrupted. In the test phase, participants moved their hands to 5 locations-the CS+, CS-, and 3 locations that lay between the 2 ("generalization stimuli"). Our primary hypothesis was supported-pain expectancy was greater at the CS+ location in the Imprecise group than in the Precise group (6.9 [SD = 1.9] vs 5.4 [SD = 2.5], P= .02). Pain expectancies generalized to novel locations similarly in both groups and there was no difference in extinction between groups. Our primary hypothesis was supported but our subsequent hypotheses were not. PERSPECTIVE: We conditioned pain expectancy at a certain location of one hand, even though most participants were unaware of the contingency. Conditioned pain expectancy was greater when sensory information about location was less precise. This adds support to the possibility that associative learning may play a role in the progression of an acute pain episode to a more generalized pain disorder.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
Publisher: Oxford University Press (OUP)
Date: 30-03-2012
DOI: 10.1093/RHEUMATOLOGY/KES048
Abstract: To determine whether motor imagery performance is disrupted in patients with painful knee OA and if this disruption is specific to the location of the pain. Twenty patients with painful knee OA, 20 patients with arm pain and 20 healthy pain-free controls undertook a motor imagery task in which they made left/right judgements of pictured hands and feet. Accuracy and reaction time of judgements were compared between groups and pain locations (side: left vs right site: upper vs lower). Patients with knee pain were less accurate (P 0.11). There were no differences in reaction time between groups (P = 0.64). Further, there was no effect of side or site of pain on reaction time (P = 0.43, 0.54, respectively) and no effect of site of pain on accuracy of left/right judgements (P = 0.12). However, there was an interaction effect of side of pain on accuracy of left vs right images (P = 0.03). If left-sided pain was present, accuracy was lower when images showed left hands/feet than when images showed right hands/feet. Motor imagery performance is disrupted in patients with knee OA, but is also disrupted in patients with arm pain. Accuracy of left/right judgements is disrupted in a spatially defined manner, raising the important possibility that brain-grounded maps of peripersonal space contribute to the cortical proprioceptive representation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-01-2022
DOI: 10.1097/J.PAIN.0000000000002605
Abstract: In this case report, we used virtual reality (VR) to explore pain evoked by only the appearance of being touched (rather than actually being touched) in a person with complex regional pain syndrome type II. Furthermore, we explored the degree to which this visually evoked pain could be extinguished by applying exposure principles in VR. In stage 1, we identified 4 specific scenarios where pain was triggered by visually simulated touch (without physical stimulation) and used these scenarios to quantify baseline sensitivity to visuotactile stimulation. In stage 2, the patient undertook a 12-week virtual exposure program, and the visual triggers were reassessed 3 weeks after the commencement and immediately upon completion of the program. At baseline, severe pain and a profound cold sensation were immediately and consistently evoked in concert with visually simulated touch. At 12-week follow-up, only one of the initially provocative visual stimuli triggered pain and only after 60 seconds of repeated stimulation. Unfortunately, the transfer of desensitisation from VR to the real world was limited. This case report describes the phenomena of visually evoked pain. Moreover, it describes the near complete extinguishing of visually evoked pain through virtual graded exposure. How improvements gained in VR might be better transferred to real-word improvements merits further investigation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2013
DOI: 10.1016/J.PAIN.2013.07.010
Abstract: Although in idual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain (LBP), a related systematic review is unavailable. Therefore, this review summarized evidence regarding the predictive value of these muscular characteristics. Candidate publications were identified from 6 electronic medical databases. After review, 5 cohort studies were included. Although this review intended to encompass studies using different muscle assessment methods, all included studies coincidentally used ultrasound imaging. No research investigated the relation between static morphometry and clinical outcomes. Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise. Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up. However, there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short- or long-term LBP intensity after exercise interventions. There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments. Given study heterogeneity, the small number of included studies and the inability of conventional greyscale B-mode ultrasound imaging to measure muscle activity, our findings should be interpreted with caution. Further large-scale prospective studies that use appropriate technology (ie, electromyography to assess muscle activity) should be conducted to investigate the predictive value of morphometry or activity of these muscles with respect to LBP-related outcomes measures.
Publisher: Oxford University Press (OUP)
Date: 06-2016
DOI: 10.2522/PTJ.20150241
Abstract: Despite common use of proprioceptive retraining interventions in people with chronic, idiopathic neck pain, evidence that proprioceptive dysfunction exists in this population is lacking. Determining whether proprioceptive dysfunction exists in people with chronic neck pain has clear implications for treatment prescription. The aim of this study was to synthesize and critically appraise all evidence evaluating proprioceptive dysfunction in people with chronic, idiopathic neck pain by completing a systematic review and meta-analysis. MEDLINE, CINAHL, PubMed, Allied and Complementary Medicine, EMBASE, Academic Search Premier, Scopus, Physiotherapy Evidence Database (PEDro), and Cochrane Collaboration databases were searched. All published studies that compared neck proprioception (joint position sense) between a chronic, idiopathic neck pain s le and asymptomatic controls were included. Two independent reviewers extracted relevant population and proprioception data and assessed methodological quality using a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Thirteen studies were included in the present review. Meta-analysis on 10 studies demonstrated that people with chronic neck pain perform significantly worse on head-to-neutral repositioning tests, with a moderate standardized mean difference of 0.44 (95% confidence interval=0.25, 0.63). Two studies evaluated head repositioning using trunk movement (no active head movement thus hypothesized to remove vestibular input) and showed conflicting results. Three studies evaluated complex or postural repositioning tests postural repositioning was no different between groups, and complex movement tests were impaired only in participants with chronic neck pain if error was continuously evaluated throughout the movement. A paucity of studies evaluating complex or postural repositioning tests does not permit any solid conclusions about them. People with chronic, idiopathic neck pain are worse than asymptomatic controls at head-to-neutral repositioning tests.
Publisher: Wiley
Date: 03-06-2022
DOI: 10.1002/EJP.1976
Abstract: Complex Regional Pain Syndrome (CRPS) is a rare but disabling pain condition. Accurate and timely education about CRPS is key to promote optimal clinical outcomes, but it is unclear what the content of that education should be. We aimed to determine the content that both people with CRPS and expert health care professionals (HCPs) reported as important. An international three‐round e‐Delphi was conducted, recruiting adults diagnosed with CRPS and HCPs. In Round 1, participants were asked to list the most important information people with CRPS should know regarding the condition . Data were organized into concepts and allocated to themes. In Rounds 2 and 3, participants rated each concept on a 9‐point Likert Scale, categorized as ‘not important’ (0–3), ‘important’ (4–6) and ‘very important’ (7–9). A concept attained consensus when ≥75% agreement was reached within a category. Sixty‐two participants (HCPs: n = 7 CRPS: n = 55) proposed 193 concepts in Round 1, resulting in 22 themes. Fifteen additional concepts were identified in Round 2, resulting in a total of 208 concepts. From that list, 48 concepts that emphasized understanding and evidence‐based management of the disorder, the importance of self‐management strategies, pacing and movement, reached joint consensus as ‘very important’. One concept: ‘Advise that movement does not help’ reached joint consensus as ‘not important’. Forty‐eight concepts were jointly considered ‘very important’ for future CRPS‐related educational content. Future research to better understand group differences and to canvas a broader HCP group is warranted. This e‐Delphi study identified the 48 core concepts that those with the lived experience of CRPS, and advanced practitioner health care professionals jointly rated as ‘very important’ to include in fundamental and accessible educational material.
Publisher: Public Library of Science (PLoS)
Date: 17-07-2013
Publisher: Oxford University Press (OUP)
Date: 14-09-2021
DOI: 10.1093/PM/PNAB261
Abstract: To determine if impairment in motor imagery processes is present in Achilles tendinopathy (AT), as demonstrated by a reduced ability to quickly and accurately identify the laterality (left-right judgement) of a pictured limb. Additionally, this study aimed to use a novel data pooling approach to combine data collected at 3 different sites via meta-analytical techniques that allow exploration of heterogeneity. Multi-site case-control study. Three independent studies with similar protocols were conducted by separate research groups. Each study-site evaluated left/right judgement performance for images of feet and hands using Recognise© software and compared performance between people with AT and healthy controls. Results from each study-site were independently collated, then combined in a meta-analysis. In total, 126 participants (40 unilateral, 22 bilateral AT cases, 61 controls) were included. There were no differences between AT cases and controls for hand image accuracy and reaction time. Contrary to the hypothesis, there were no differences in performance between those with AT and controls for foot image reaction time, however there were conflicting findings for foot accuracy, based on four separate analyses. There were no differences between the affected and unaffected sides in people with unilateral AT. Impairments in motor imagery performance for hands were not found in this study, and we found inconsistent results for foot accuracy. This contrasts to studies in persistent pain of limbs, face and knee osteoarthritis, and suggests that differences in pathoetiology or patient demographics may uniquely influence proprioceptive representation.
Publisher: CSIRO Publishing
Date: 24-11-2021
DOI: 10.1071/PY21066
Abstract: Complex regional pain syndrome (CRPS) is a distressing and disabling pain condition. Many people with CRPS and the health professionals who treat them seek information about the condition via the Internet. The credibility, accuracy and comprehensiveness of online CRPS information remains unknown. The aim of this study was to determine the credibility, accuracy and comprehensiveness of information presented on freely accessible websites that aim to educate people about CRPS. Keyword searches were conducted on the Australian Google site, with ‘trustworthy’ websites included and critically appraised. Primary outcomes were recognised metrics of credibility (JAMA benchmark credibility criteria) and website accuracy (according to European CRPS guidelines). Comprehensiveness was assessed using the proportion of European CRPS guidelines covered by the websites. In all, 30 websites with 819 recommendations were critically appraised. Five (17%) websites met all credibility criteria of the recommendations, 349 (43%) were accurate, 252 (31%) were inaccurate and 218 (26%) were unclear. For comprehensiveness, an average of 17% of general guidelines, 15% of therapeutic guidelines and 6% of medication/supplement guidelines were covered. Online information about CRPS available to Australians has low credibility, accuracy and comprehensiveness. Many website recommendations are inaccurate or unclear, and many websites endorse inappropriate treatments. There is an urgent need for accurate and comprehensive sources of CRPS information online.
Publisher: Frontiers Media SA
Date: 07-01-2022
Publisher: Informa UK Limited
Date: 27-03-2020
Publisher: Springer Science and Business Media LLC
Date: 16-06-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2019
DOI: 10.1097/PR9.0000000000000795
Abstract: Resizing illusions that manipulate perceived body size are analgesic in some chronic pain conditions. Little is known whether such illusions may also alter other physiological features, such as swelling. To determine the effects of a knee resizing illusion on knee pain and swelling in symptomatic osteoarthritis. This case study was extracted from a larger study evaluating the analgesic effects of resizing illusions in people with knee osteoarthritis. A mediated reality system (alters real-time video) was used to provide resizing “stretch” and “shrink” illusions of the knee. Knee pain intensity (0–100 numerical rating scale) was measured before and after illusion and after sustained (3 minutes) and repeated (n = 10) illusions. In this case study, knee swelling (leg circumference below, at, and above the knee) was also measured. The 55-year-old male participant reported a long history of episodic knee pain and swelling that was subsequently diagnosed as severe osteoarthritis in 2013. In the first testing session, the participant experienced an increase in pain with the shrink illusion and a decrease in pain with stretch illusion. A noticeable increase in knee swelling was also observed. Thus, in sessions 2/3, swelling was also assessed. The stretch illusion decreased pain to the largest extent, but resulted in increased knee swelling. Repeated and sustained stretch illusions had cumulative analgesic effects but resulted in cumulative increases in swelling. While the shrink illusion increased pain, sustained (∼10 minutes) visual minification of the entire knee and leg reduced both pain and swelling. Our case report suggests that both pain and swelling may be modifiable by altering body-relevant sensory input in symptomatic knee osteoarthritis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2020
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 10-2021
Publisher: American Medical Association (AMA)
Date: 02-08-2022
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1016/J.MATH.2008.01.011
Abstract: The reliability of manual methods to assess spinal stiffness is modest at best. In response, instrumentation has been developed which may be reliable, but is often difficult to use in clinical settings. The purpose of this study was to determine the intra-rater reliability of assisted indentation (AI), a smaller, less automated technique of measuring spinal stiffness in vivo. Twenty-three asymptomatic subjects were included in the study. The AI device was placed over the 4th lumbar spinous process in each prone, resting subject. Ten indentations were performed at approximately 2-min intervals while load and displacement data were collected simultaneously. From these data, two outcome variables were calculated: Global Stiffness (GS slope of the force-displacement data) and Mean Maximal Stiffness (MMS peak force eak displacement). Intra-class correlation coefficient values for 10 consecutive measures of GS and MMS were 0.93 and 0.91, respectively. A repeated measures analysis of variance (ANOVA) did not demonstrate significant differences between any indentation trials from the same subject. Measurement of spinal stiffness using AI demonstrated excellent intra-rater reliability. These data, in addition to specific features of AI (small, transportable, relatively low cost, ease of operation) suggest that AI may be of benefit within clinical environments.
Publisher: Wiley
Date: 20-11-2020
DOI: 10.1002/EJP.1687
Publisher: ACM
Date: 19-04-2023
Publisher: Springer Science and Business Media LLC
Date: 18-11-2010
Publisher: Springer Science and Business Media LLC
Date: 02-11-2021
DOI: 10.1007/S00426-021-01609-Z
Abstract: Body re-sizing illusions can profoundly alter perception of our own body. We investigated whether creating the illusion of a muscled and fit-looking back (Strong) influenced perceived back size, body ownership, and attitudes towards self-capacity during a lifting task. Twenty-four healthy male volunteers performed a standardised lifting task while viewing real-time (delay 20 ms) video of their own back through a head-mounted display under four different conditions (Normal size, Strong, Reshaped, Large order randomised). The MIRAGE-mediated reality system was used to modify the shape, size, and morphology of the back. Participants were poor at recognizing the correct appearance of their back, for both implicit (perceived width of shoulders and hips) and explicit (questionnaire) measures of back size. Visual distortions of body shape (Reshaped condition) altered implicit back size measures. However, viewing a muscled back (Strong condition) did not result in a sense of agency or ownership and did not update implicit perception of the back. No conditions improved perceptions/attitudes of self-capacity (perceived back strength, perceived lifting confidence, and perceived back fitness). The results lend support for the importance of the embodiment of bodily changes to induce changes in perception. Further work is warranted to determine whether increased exposure to illusory changes would alter perceptions and attitudes towards self-capacity or whether different mechanisms are involved.
Publisher: PeerJ
Date: 14-02-2020
DOI: 10.7717/PEERJ.8553
Abstract: People with chronic neck pain have impaired proprioception (i.e., sense of neck position). It is unclear whether this impairment involves disruptions to the proprioceptive representation in the brain, peripheral factors, or both. Implicit motor imagery tasks, namely left/right judgements of body parts, assess the integrity of the proprioceptive represention. Previous studies evaluating left/right neck judgements in people with neck pain are conflicting. We conducted a large online study to comprehensively address whether people with neck pain have altered implicit motor imagery performance. People with and without neck pain completed online left/right neck judgement tasks followed by a left/right hand judgement task (control). Participants judged whether the person in the image had their head rotated to their left or right side (neck task) or whether the image was of a left hand or a right hand (hand task). Participants were grouped on neck pain status (no pain months—acute ≥3 months—chronic) and pain location (none, left-sided, right-sided, bilateral). Outcomes included accuracy (primary) and response time (RT secondary). Our hypotheses—that (i) chronic neck pain is associated with disrupted performance for neck images and (ii) the disruption is dependent on the side of usual pain, were tested with separate ANOVAs. A total of 1,404 participants were recruited: 105 reported acute neck pain and 161 reported chronic neck pain. When grouped on neck pain status, people with chronic neck pain were less accurate than people without neck pain ( p = 0.001) for left/right neck judgements, but those with acute neck pain did not differ from those without neck pain ( p = 0.14) or with chronic neck pain ( p = 0.28). Accuracy of left/right hand judgements did not differ between groups ( p = 0.58). RTs did not differ between groups for any comparison. When grouped on neck pain location, people were faster and more accurate at identifying right-turning neck images than left-turning neck images, regardless of history or location of pain ( p 0.001 for both) people with no pain were more accurate and faster than people with bilateral neck pain ( p = 0.001, p = 0.015) and were faster than those with left-sided neck pain ( p = 0.021) people with right-sided neck pain were more accurate than people with bilateral neck pain ( p = 0.018). Lastly, there was a significant interaction between neck image and side of neck pain: people with right-sided neck pain were more accurate at identifying right-sided neck turning images than people with left-sided neck pain ( p = 0.008), but no different for left-sided neck turning images ( p = 0.62). There is evidence of impaired implicit motor imagery performance in people with chronic neck pain, which may suggest disruptions to proprioceptive representation of the neck. These disruptions seem specific to the neck (performance on hand images intact) but non-specific to the exact location of neck pain.
Publisher: Informa UK Limited
Date: 03-07-2019
Publisher: Springer Science and Business Media LLC
Date: 03-01-2021
Publisher: Oxford University Press (OUP)
Date: 02-2008
DOI: 10.2522/PTJ.20070147
Abstract: The methodological quality of randomized controlled trials (RCTs) is commonly evaluated in order to assess the risk of biased estimates of treatment effects. The purpose of this systematic review was to identify scales used to evaluate the methodological quality of RCTs in health care research and summarize the content, construction, development, and psychometric properties of these scales. Extensive electronic database searches, along with a manual search, were performed. One hundred five relevant studies were identified. They accounted for 21 scales and their modifications. The majority of scales had not been rigorously developed or tested for validity and reliability. The Jadad Scale presented the best validity and reliability evidence however, its validity for physical therapy trials has not been supported. Many scales are used to evaluate the methodological quality of RCTs, but most of these scales have not been adequately developed and have not been adequately tested for validity and reliability. A valid and reliable scale for the assessment of the methodological quality of physical therapy trials needs to be developed.
Publisher: Oxford University Press (OUP)
Date: 04-2009
Publisher: Walter de Gruyter GmbH
Date: 10-2016
DOI: 10.1016/J.SJPAIN.2016.06.004
Abstract: Recent evidence demonstrated that complex regional pain syndrome (CRPS) is associated with a larger than normal somatosensory (S1) representation of the healthy hand. The most intuitive mechanism for this apparent enlargement is increased, i.e. compensatory, use of the healthy hand. We investigated whether enlargement of the S1 representation of the healthy hand is associated with compensatory use in response to CRPS. Specifically, we were interested in whether the size of the S1 representation of the healthy hand is associated with the severity of functional impairment of the CRPS-affected hand. We were also interested in whether CRPS duration might be positively associated with the size of the representation of the healthy hand in S1. Using functional magnetic resonance imaging (fMRI) data from our previous investigation, the size of the S1 representation of the healthy hand in CRPS patients ( n = 12) was standardised to that of a healthy control s le ( n = 10), according to hand dominance. Responses to questionnaires on hand function, overall function and self-efficacy were used to gather information on hand use in participants. Multiple regression analyses investigated whether the S1 representation was associated with compensatory use. We inferred compensatory use with the interaction between reported use of the CRPS-affected hand and (a) reported overall function, and (b) self-efficacy. We tested the correlation between pain duration and the size of the S1 representation of the healthy hand with Spearman’s rho. The relationship between the size of the S1 representation of the healthyh and and the interaction between use of the affected hand and overall function was small and non-significant ( β =-5.488×10 -5 , 95% C.I. –0.001, 0.001). The relationship between the size of the S1 representation of the healthy hand and the interaction between use of the affected hand and self-efficacy was also small and non-significant ( β =-6.027×10 -6 , 95% C.I. –0.001, 0.001). The S1 enlargement of the healthy hand was not associated with pain duration (Spearman’s rho = –0.14, p = 0.67). Our exploration did not yield evidence of any relationship between the size of the healthy hand representation in S1 and the severity of functional impairment of the CRPS-affected hand, relative to overall hand use or to self-efficacy. There was also no evidence of an association between the size of the healthy hand representation in S1 and pain duration. The enlarged S1 representation of the healthy hand does not relate to self-reported function and impairment in CRPS. While this study had a hypothesis-generating nature and the s le was small, there were no trends to suggest compensatory use as the mechanism underlying the apparent enlargement of the healthy hand in S1. Further studies are needed to investigate the possibility that inter-hemispheric differences seen in S1 in CRPS may be present prior to the development of the disorder.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Wiley
Date: 22-10-2015
DOI: 10.1002/EJP.801
Abstract: The spatial precision of expectancy effects on pain is unclear. We hypothesized that expecting nociceptive stimuli at particular skin sites would have an analgesic effect on nociceptive stimuli presented between them (middle zone). Laser stimuli (evoking pin-prick pain) were delivered to three discrete skin zones on the forearm, under two conditions. During 'Localization', participants' expectation of stimuli was spatially ided between two locations (expected stimuli in only the outer two skin zones): pain intensity and stimulus location were judged. During 'No-localization' (control condition), participants had no expectation concerning stimulus location only pain intensity was rated. Additional experiments assessed the importance of the actual location on the forearm by: shifting all skin zones proximally towards the elbow (control for joint proximity, Experiment 2) adding a fourth zone distally (control for interaction between joint proximity and enhanced distal inhibition, Experiment 3). All experiments demonstrated spatially specific pain modulation, but only Experiment 2 (near elbow) supported our hypothesis: middle zone pain intensity was significantly lower (p = 0.02) during Localization than No-localization. Experiment 1 (near wrist) found reduced pain intensity during Localization only for the distal zone (p = 0.04). Experiment 3 confirmed this effect: reduced pain during Localization occurred only for the most distal zone (p = 0.046). Expecting a painful stimulus in non-adjacent skin sites has spatially specific effects on pain modulation, but this reflects an interaction between the expected location of stimulation and the actual location. This suggests a more complex connection between somatotopic maps and nociceptive modulation than previously thought several distinct mechanisms likely contribute.
Publisher: JMIR Publications Inc.
Date: 02-07-2021
DOI: 10.2196/26053
Abstract: Chronic low back pain (CLBP) is a global health problem associated with an increasing burden on in iduals, health care systems, and society. Common treatments for people with CLBP produce, on average, small short-term improvements in pain and function compared with minimal care. The RESOLVE trial randomly allocated 276 people with CLBP to a new complex treatment strategy, pain education integrated with graded sensorimotor precision training (RESOLVE), or a sham control. The RESOLVE treatment was developed within a theoretical framework to target possible treatment mechanisms associated with CLBP development and persistence. This protocol describes the planned evaluation of these proposed treatment mechanisms. Improved understanding of the mechanisms underpinning the RESOLVE treatment may guide its refinement and implementation. We will use causal mediation analysis to evaluate the proposed treatment mechanisms, including pain self-efficacy, back beliefs, pain catastrophizing, kinesiophobia, back perception, tactile acuity, and movement coordination. The primary outcomes are pain intensity and function at 18 weeks following allocation. Data were collected blind to allocation and hypotheses at baseline (mediators, outcomes, confounders), end of treatment (mediators), and at 18 weeks following allocation (outcomes). We will test the robustness of our findings by conducting planned sensitivity analyses. Ethical approval was granted by the University of New South Wales Human Research Ethics Committee (HC15357). A total of 276 participants have been recruited from primary care practices and the community in Sydney, Australia. The RESOLVE treatment constitutes a new paradigm for CLBP management with potentially wide-reaching implications. This mechanistic evaluation will provide evidence for the hypothesized treatment mechanisms and help explain why the treatment strategy did or did not have an effect on patient-reported outcomes. These results will help guide the treatment refinement and implementation. Australian and New Zealand Clinical Trials Registry ACTRN12615000610538 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619& isReview=true DERR1-10.2196/26053
Publisher: PeerJ
Date: 03-05-2021
DOI: 10.7717/PEERJ.11301
Abstract: Proprioception refers to the perception of motion and position of the body or body segments in space. A wide range of proprioceptive tests exists, although tests dynamically evaluating sensorimotor integration during upper limb movement are scarce. We introduce a novel task to evaluate kinesthetic proprioceptive function during complex upper limb movements using a robotic device. We aimed to evaluate the test–retest reliability of this newly developed Dynamic Movement Reproduction (DMR) task. Furthermore, we assessed reliability of the commonly used Joint Reposition (JR) task of the elbow, evaluated the association between both tasks, and explored the influence of visual information (viewing arm movement or not) on performance during both tasks. During the DMR task, participants actively reproduced movement patterns while holding a handle attached to the robotic arm, with the device encoding actual position throughout movement. In the JR task, participants actively reproduced forearm positions with the final arm position evaluated using an angle measurement tool. The difference between target movement pattern osition and reproduced movement pattern osition served as measures of accuracy. In study 1 ( N = 23), pain-free participants performed both tasks at two test sessions, 24-h apart, both with and without visual information available (i.e., vision occluded using a blindfold). In study 2 ( N = 64), an independent s le of pain-free participants performed the same tasks in a single session to replicate findings regarding the association between both tasks and the influence of visual information. The DMR task accuracy showed good-to-excellent test–retest reliability, while JR task reliability was poor: measurements did not remain sufficiently stable over testing days. The DMR and JR tasks were only weakly associated. Adding visual information (i.e., watching arm movement) had different performance effects on the tasks: it increased JR accuracy but decreased DMR accuracy, though only when the DMR task started with visual information available (i.e., an order effect). The DMR task’s highly standardized protocol (i.e., largely automated), precise measurement and involvement of the entire upper limb kinetic chain (i.e., shoulder, elbow and wrist joints) make it a promising tool. Moreover, the poor association between the JR and DMR tasks indicates that they likely capture unique aspects of proprioceptive function. While the former mainly captures position sense, the latter appears to capture sensorimotor integration processes underlying kinesthesia, largely independent of position sense. Finally, our results show that the integration of visual and proprioceptive information is not straightforward: additional visual information of arm movement does not necessarily make active movement reproduction more accurate, on the contrary, when movement is complex, vision appears to make it worse.
Publisher: Wiley
Date: 29-05-2017
DOI: 10.1111/PAPR.12586
Abstract: There is a growing interest in the role of disturbed body perception in people with persistent pain problems such as chronic low back pain (CLBP). A questionnaire, the Fremantle Back Awareness Questionnaire (FreBAQ), was recently developed as a simple and quick way of assessing disturbed perceptual awareness of the back in people with CLBP and appears to have acceptable psychometric properties. The aim of the present study was to develop a Japanese version of the FreBAQ (FreBAQ-J) and evaluate its psychometric properties in a s le of Japanese people with low back pain (LBP). Translation of the FreBAQ into Japanese was conducted using a forward-backward method. One hundred participants with LBP completed the resultant FreBAQ-J. A subset of the participants completed the FreBAQ-J again 2 weeks later. Validity was investigated by examining the relationship between the FreBAQ-J and clinical valuables. Rasch analysis was used to assess targeting, category ordering, unidimensionality, person fit, internal consistency, and differential item functioning. The FreBAQ-J was significantly correlated with pain in motion, disability, pain-related catastrophizing, fear of movement, and anxiety symptomatology. The FreBAQ-J had acceptable internal consistency, a minor departure from unidimensionality, and good test-retest reliability, and was functional on the category rating scale. The FreBAQ-J has acceptable psychometric properties and is suitable for use in people with LBP. Participants with high levels of disturbed body perception are well targeted by the scale. The functioning of one item (item 8) was poor. Further study is warranted to confirm if this item should be excluded.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JPAIN.2015.05.007
Abstract: Upper limb fracture is a common musculoskeletal injury and can lead to marked pain-related disability. Unlike other common painful musculoskeletal conditions, such as low back pain, little consideration has been given to the role that psychological variables may play in explaining the relationship between pain and disability during early fracture recovery. This cross-sectional study aimed to determine if psychological distress (symptoms of depression, anxiety, and/or stress) mediate the relationship between pain and disability in acute hand/wrist fractures. Self-reported data from a consecutive s le of 594 patients with acute hand/wrist fracture were used. Mediation analyses were conducted to determine the role of depression, anxiety, and stress in the relationship between pain and disability, controlling for relevant demographic and fracture-related variables. Depression and stress, but not anxiety, significantly mediated the relationship between pain and disability. That is, although each psychological distress variable was associated with pain (P < .001), only depression (b1 = 0.27, P = .03) and stress (b3 = .23, P = .02) were significantly associated with disability and fulfilled recommended criteria for establishing a mediating variable. Increased depression and stress, but not anxiety, explain the relationship between pain and disability and may be novel targets for interventions designed to reduce pain-related disability after upper limb fracture. Perspective: This study presents the mediating effect of psychological distress on the relationship between pain and disability in acute upper limb fracture. These factors may be novel targets for interventions designed to reduce pain-related disability after acute fracture.
Publisher: Wiley
Date: 24-10-2016
DOI: 10.1002/EJP.934
Publisher: Public Library of Science (PLoS)
Date: 26-06-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-12-2013
Publisher: Elsevier BV
Date: 09-2021
Publisher: Springer Science and Business Media LLC
Date: 28-08-2021
DOI: 10.1186/S12891-021-04561-6
Abstract: Despite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an in idualised walking, strengthening, and general education program. Two-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an in idualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA ain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy erceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes. We will determine whether the integration of PSE into an in idualised OA education, walking, and strengthening program is more effective than receiving the in idualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA. Australian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020).
Publisher: Wiley
Date: 28-06-2020
DOI: 10.1111/JOP.13065
Publisher: Mary Ann Liebert Inc
Date: 10-2019
Abstract: Pain is an understudied and undertreated consequence of cancer survival. Pain education is now a recommended treatment approach for persistent non-cancer pain, yet it has not been well applied to the context of adolescent and young adult (AYA) cancer survival. In March 2018, an interdisciplinary meeting was held in Adelaide, South Australia to set a research agenda for pain education in AYA cancer survivors. We identified that AYAs with persistent pain and those with heightened pain-related fear have the potential to benefit from pain education. We identified a number of unique challenges of engaging AYA survivors in pain education, and point towards future research directions.
Publisher: Oxford University Press (OUP)
Date: 14-12-2016
DOI: 10.1093/PM/PNV044
Abstract: Clinical scenarios of repeated pain usually involve both nociceptive and non-nociceptive input. It is likely that associations between these stimuli are learned over time. Such learning may underlie subsequent lification of pain, or evocation of pain in the absence of nociception. We undertook a systematic review and meta-analysis to evaluate the evidence that allodynia or hyperalgesia can be a classically conditioned response. A sensitive search of the literature covered Medline, Embase, CINAHL, AMED, PubMed, Scopus, PsycArticles, PsycINFO, Cochrane Library, and Web of Science. Additional studies were identified by contacting experts and searching published reviews. Two reviewers independently assessed studies for inclusion, evaluated risk of bias, and extracted data. Studies were included if they aimed to elicit or lify pain using a classical conditioning procedure in healthy, adult humans. Studies were excluded if they did not distinguish between classical conditioning and explicit verbal suggestion as learning sources, or did not use experiential learning. Thirteen studies, with varying risk of bias, were included. Ten studies evaluated classically conditioned hyperalgesia: nine found hyperalgesia one did not. Pooled effects (n = 8 with full data) showed a significant pain increase after conditioning (mean difference of 7.40 [95%CI: 4.00-10.80] on a 0-100 pain scale). Three studies evaluated conditioned allodynia and found conflicting results. The existing literature suggests that classical conditioning can lify pain. No conclusions can be drawn about whether or not classical conditioning can elicit pain. Rigorous experimental conditioning studies with nociceptive unconditioned stimuli are needed to fill this gap in knowledge.
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 10-2021
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.APMR.2011.11.035
Abstract: To propose standardized, patient-centered measures of recovery from nonspecific low back pain (LBP) in research, underpinned by an empirically derived concept of recovery and informed by expert opinion. Synthesis of literature reviews and expert panel opinion. Primary care centers for the management of nonspecific LBP. Persons with nonspecific LBP. Conservative treatments for nonspecific LBP. Three phases of research were conducted. First, qualitative research that explored patients' perspectives of recovery from nonspecific LBP was reviewed. Second, measures of recovery used in LBP clinical trials during the past decade were investigated in a systematic review. Third, opinion was sought from an expert panel of clinicians and researchers about how to measure recovery from nonspecific LBP, in a workshop at the 10th International Forum for Primary Care Research in Low Back Pain. An empirically derived and patient-centered concept of recovery from nonspecific LBP was developed from the qualitative research phase. The systematic review conducted in the second study phase revealed that researchers have used vastly heterogeneous measures of LBP recovery in clinical trials during the past decade. Finally, the key conclusions of the LBP Forum workshop were (1) that appropriate patient-centered instruments to measure recovery include global measures and patient-specific measures and (2) that the benefits of implementing the same recovery measures for acute and chronic LBP outweigh the disadvantages of using different measures. The results were synthesized to inform our recommendation that researchers consider adopting 2 instruments as standardized measures of recovery from nonspecific LBP, as an adjunct to the existing core set of LBP outcome measures. These instruments are an 11-point Global Back Recovery Scale, for a simple measure of global recovery, and the Patient-Generated Index of Quality of Life-Back Pain, to evaluate specific relevant dimensions of recovery. This recommendation has majority endorsement by members of the Australian National Health and Medical Research Council Acute Low Back Pain Review Group.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-02-2021
DOI: 10.1097/J.PAIN.0000000000002244
Abstract: Pain education is a popular treatment approach for persistent pain that involves learning a variety of concepts about pain (ie, target concepts), which is thought to be an important part of recovery. Yet, little is known about what patients value learning about pain. A mixed-methods survey was conducted to identify pain concepts that were valued by people with persistent pain who improved after a pain science education intervention. An online survey was distributed to 123 people who were treated for persistent pain with a pain science education approach responses of participants who self-identified as “improved” were analysed. Open-ended survey questions were analysed using reflexive thematic analysis and close-ended questions were analysed for frequency of responses. Each question-type was analysed separately, before integration for complementarity. We analysed the data of 97 participants. We constructed 3 themes from the open-ended questions. Pain does not mean my body is damaged (theme 1) captured the importance of abandoning preexisting ideas that pain indicated damage. Thoughts, emotions and experiences affect pain (theme 2) captured the value of recognising multifactorial influences on pain. I can retrain my overprotective pain system (theme 3) captured the importance of conceptualising pain as a heightened protective response that could be lessened. Responses from close-ended questions confirmed that the target concepts represented by these themes are among those most valued, although ergence with the qualitative data suggests differences between patient and clinician language. These data offer patient-centred conceptualizations and language that could assist in further refining pain education interventions.
Publisher: Elsevier BV
Date: 06-2023
Publisher: MDPI AG
Date: 16-02-2021
Abstract: Clinicians have an increasing number of evidence-based interventions to treat pain in youth. Mediation analysis offers a way of investigating how interventions work, by examining the extent to which an intermediate variable, or mediator, explains the effect of an intervention. This systematic review examined studies that used mediation analysis to investigate mechanisms of interventions on pain-relevant outcomes for youth (3–18 years) with acute or chronic pain, and provides recommendations for future mediation research in this field. We searched five electronic databases for clinical trials or observational longitudinal studies that included a comparison group and conducted mediation analyses of interventions on youth and assessed pain outcomes. We found six studies (N = 635), which included a total of 53 mediation models examining how interventions affect pain-relevant outcomes for youth. Five studies were secondary analyses of randomized controlled trials of psychological interventions for chronic pain one was a longitudinal observational study of morphine for acute pain. The pain conditions studied were irritable bowel syndrome, functional abdominal pain, juvenile fibromyalgia, mixed chronic pain, and post-operative pain. Fourteen putative mediators were tested, of which three partially mediated treatment effect seven did not significantly mediate treatment effect and four had mixed results. Methodological and reporting limitations were common. There are substantial gaps in the field with respect to investigating, and therefore understanding, how paediatric interventions work.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.JPAIN.2021.10.001
Abstract: Pain interventions typically include effortful exercise and long-term treatment - ie, short-term costs (effort) with delayed benefit (improved pain and/or function). Thus, understanding if long-term pain influences decision-making in context of delays and effort is essential given clear relevance to treatment uptake and/or adherence. We evaluated delay and effort attitudes in those experiencing chronic pain (n = 391) and in pain-free controls (n = 263). Additionally, we investigated the role of bodily sensation awareness and/or interpretation as potential contributing factors to altered decision-making. Volunteers completed three discounting questionnaires, assessing the influence of temporal delays (gains, losses) and effort on devaluation of monetary outcomes. In iduals with chronic pain had more short-sighted decisions for monetary gains, but not losses, and decreased willingness to undertake effort for monetary gains than the No Pain group. The Pain group had higher bodily sensation awareness and while this related to higher impulsivity, delay and effort discounting, neither awareness nor interpretation of bodily sensations interacted with pain levels or explained group differences in discounting behavior. These findings suggest that impaired delay and effort-based discounting is present in people with chronic pain, and that this may be driven by pain-induced changes, but not pain-induced enhancements in bodily sensation awareness and/or interpretation. Exploring the utility of interventions targeting discounting behavior is warranted. Data availability: Study materials are available here: osf.io/zexm7/?view_only=c9848597361c41808c612874da6f33b7. PERSPECTIVE: People with chronic pain make more short-sighted decisions (prefer less reward sooner) and decreased willingness to undertake effort (prefer less reward with little effort) for monetary gains than people without pain. Interventions targeting discounting behavior may help improve both uptake and adherence for evidence-based, effortful treatments, such as exercise.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Oxford University Press (OUP)
Date: 04-2011
DOI: 10.2522/PTJ.20100272
Abstract: Several studies have investigated criteria for classifying patients with low back pain (LBP) into treatment-based subgroups. A comprehensive algorithm was created to translate these criteria into a clinical decision-making guide. This study investigated the translation of the in idual subgroup criteria into a comprehensive algorithm by studying the prevalence of patients meeting the criteria for each treatment subgroup and the reliability of the classification. This was a cross-sectional, observational study. Two hundred fifty patients with acute or subacute LBP were recruited from the United States and Australia to participate in the study. Trained physical therapists performed standardized assessments on all participants. The researchers used these findings to classify participants into subgroups. Thirty-one participants were reassessed to determine interrater reliability of the algorithm decision. Based on in idual subgroup criteria, 25.2% (95% confidence interval [CI]=19.8%-30.6%) of the participants did not meet the criteria for any subgroup, 49.6% (95% CI=43.4%-55.8%) of the participants met the criteria for only one subgroup, and 25.2% (95% CI=19.8%-30.6%) of the participants met the criteria for more than one subgroup. The most common combination of subgroups was manipulation + specific exercise (68.4% of the participants who met the criteria for 2 subgroups). Reliability of the algorithm decision was moderate (kappa=0.52, 95% CI=0.27-0.77, percentage of agreement=67%). Due to a relatively small patient s le, reliability estimates are somewhat imprecise. These findings provide important clinical data to guide future research and revisions to the algorithm. The finding that 25% of the participants met the criteria for more than one subgroup has important implications for the sequencing of treatments in the algorithm. Likewise, the finding that 25% of the participants did not meet the criteria for any subgroup provides important information regarding potential revisions to the algorithm's bottom table (which guides unclear classifications). Reliability of the algorithm is sufficient for clinical use.
Publisher: Wiley
Date: 28-09-2020
DOI: 10.1002/EJP.1657
Publisher: Elsevier BV
Date: 10-2006
DOI: 10.1016/J.JMPT.2006.08.013
Abstract: The goal of this study was to compare the variation of manipulative forces produced by instruments and a manual technique. Four operators (2 experts and 2 novices) used 4 different mechanical instruments to apply force to a uniaxial load cell. A different group of 2 expert and 2 novice operators used a traditional manual technique to apply force to a sensor mat. Two primary outcome variables were obtained from each sensor system: peak-to-peak force magnitude (N) and peak-to-peak force duration (millisecond). Multiple analyses were performed to determine the absolute differences and variation in each variable. Force-producing instrumentation exhibited less variation in absolute force and force duration compared to manual techniques. However, the same instrument in the hands of different operators often produced significantly different values of absolute force and force duration. Although absolute values of force magnitude generally differed between operators, intraoperator variation was equal for instruments and the manual technique. Conversely, for force duration, significant differences in interoperator variability were observed for the manual technique and for one of the instruments. Force-producing instruments reduce absolute variation in force magnitude and duration. However, this reduction does not eliminate significant differences in absolute force parameters observed to occur between some operators using the same instrument. Given these observations, claims of instrument superiority that do not account for interoperator variability should be considered with caution.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.JPAIN.2013.07.004
Abstract: Dysfunction in the central nervous system is thought to underlie the movement disorders that commonly occur in complex regional pain syndrome (CRPS), with much of the literature focusing on reorganization of the primary motor cortex (M1). Presumed changes in the M1 representation of the CRPS-affected body part have contributed to new CRPS treatments, which are increasingly being integrated in the clinic. We systematically investigated the evidence for altered M1 function in CRPS. We adhered to rigorous systematic review procedure in our search strategy, risk-of-bias appraisal, and data extraction. Eighteen studies comprising 14 unique data sets were included. The included studies used several neuroimaging techniques, whose outcomes we grouped into M1 cortical excitability, spatial representation, reactivity, and glucose metabolism, and conducted meta-analyses where possible. Risk of bias across studies was high, mainly due to missing data and unblinded assessment of outcomes. No definitive conclusions can be drawn regarding M1 spatial representation, reactivity, or glucose metabolism in CRPS. There is limited evidence for bilateral M1 disinhibition in CRPS of the upper limb. Despite widely held assumptions of primary motor cortex dysfunction in complex regional pain syndrome, there is only evidence to support bilateral disinhibition, and there is high risk of bias across the literature.
Publisher: Public Library of Science (PLoS)
Date: 15-08-2019
Publisher: Oxford University Press (OUP)
Date: 11-2014
DOI: 10.2522/PTJ.20140014
Abstract: Current treatments for low back pain have small effects. A research priority is to identify patient characteristics associated with larger effects for specific interventions. The aim of this study was to identify simple clinical characteristics of patients with chronic low back pain who would benefit more from either motor control exercises or graded activity. This study was a secondary analysis of the results of a randomized controlled trial. One hundred seventy-two patients with chronic low back pain were enrolled in the trial, which was conducted in Australian physical therapy clinics. The treatment consisted of 12 initial exercise sessions over an 8-week period and booster sessions at 4 and 10 months following randomization. The putative effect modifiers (psychosocial features, physical activity level, walking tolerance, and self-reported signs of clinical instability) were measured at baseline. Measures of pain and function (both measured on a 0–10 scale) were taken at baseline and at 2, 6, and 12 months by a blinded assessor. Self-reported clinical instability was a statistically significant and clinically important modifier of treatment response for 12-month function (interaction: 2.72 95% confidence interval=1.39 to 4.06). Participants with high scores on the clinical instability questionnaire (≥9) did 0.76 points better with motor control exercises, whereas those who had low scores (& ) did 1.93 points better with graded activity. Most other effect modifiers investigated did not appear to be useful in identifying preferential response to exercise type. The psychometric properties of the instability questionnaire have not been fully tested. A simple 15-item questionnaire of features considered indicative of clinical instability can identify patients who respond best to either motor control exercises or graded activity.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.JPAIN.2021.04.007
Abstract: The Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale ("B-CRPS-BPDS") measures alterations in body perception. We assessed its internal consistency, known group validity, construct validity, and associations with demographic and clinical characteristics. We also evaluated changes in, and baseline predictors of B-CRPS-BPDS scores at follow-up. We included people with CRPS (N = 114) and pain-free controls (N = 69). People with CRPS obtained higher scores than pain-free controls on all B-CRPS-BPDS items, except the item on attention. Because this item also had an insufficient corrected item-total correlation, we propose a revised B-CRPS-BPDS (r-B-CRPS-BPDS) excluding this item. The internal consistency of the r-B-CRPS-BPDS was good. The r-B-CRPS-BPDS showed a large positive relationship with "motor neglect-like symptoms", indicating good construct validity. The r-B-CRPS-BPDS showed positive relationships with pain intensity, fear of movement, depression, and upper limb disability. There were no independent relationships with handedness, affected side, affected limb, disease duration, CRPS severity score, tension, anger, fatigue, confusion, and vigour. Finally, r-B-CRPS-BPDS scores did not consistently change over time. Our results demonstrate the utility of the r-B-CRPS-BPDS for measuring body perception disturbances in CRPS. PERSPECTIVE: This article evaluates the validity of the Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale ("B-CRPS-BPDS") in CRPS, and assesses relationships with demographic and clinical variables. The proposed revised B-CRPS-BPDS appears to be a valid measure of body perception disturbances in CRPS.
Publisher: PeerJ
Date: 20-08-2021
DOI: 10.7717/PEERJ.11882
Abstract: Anecdotally, people living with Complex Regional Pain Syndrome (CRPS) often report difficulties in localising their own affected limb when it is out of view. Experimental attempts to investigate this report have used explicit tasks and yielded varied results. Here we used a limb localisation task that interrogates implicit mechanisms because we first induce a compelling illusion called the Disappearing Hand Trick (DHT). In the DHT, participants judge their hands to be close together when, in fact, they are far apart. Sixteen volunteers with unilateral upper limb CRPS (mean age 39 ± 12 years, four males), 15 volunteers with non-CRPS persistent hand pain (‘pain controls’ mean age 58 ± 13 years, two males) and 29 pain-free volunteers (‘pain-free controls’ mean age 36 ± 19 years, 10 males) performed a hand-localisation task after each of three conditions: the DHT illusion and two control conditions in which no illusion was performed. The conditions were repeated twice (one for each hand). We hypothesised that (1) participants with CRPS would perform worse at hand self-localisation than both the control s les (2) participants with non-CRPS persistent hand pain would perform worse than pain-free controls (3) participants in both persistent pain groups would perform worse with their affected hand than with their unaffected hand. Our first two hypotheses were not supported. Our third hypothesis was supported —when visually and proprioceptively encoded positions of the hands were incongruent ( i.e . after the DHT), relocalisation performance was worse with the affected hand than it was with the unaffected hand. The similar results in hand localisation in the control and pain groups might suggest that, when implicit processes are required, people with CRPS’ ability to localise their limb is preserved.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2013
DOI: 10.1016/J.PAIN.2013.03.002
Abstract: People with chronic pain commonly report impaired cognitive function. However, to date, there has been no systematic evaluation of the body of literature concerning cognitive impairment and pain. Nor have modern meta-analytical methods been used to verify and clarify the extent to which cognition may be impaired. The objective of this study was to systematically evaluate and critically appraise the literature concerning working memory function in people with chronic pain. The study was conducted along Cochrane collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A sensitive search strategy was designed and conducted with the help of an expert librarian using 6 databases. Twenty-four observational studies evaluating behavioural and/or physiological outcomes in a chronic pain group and a control group met the inclusion criteria. All studies had a high risk of bias, owing primarily to lack of assessor blinding to outcome. High heterogeneity within the field was found with the inclusion of 24 papers using 21 different working memory tests encompassing 9 different working memory constructs and 9 different chronic pain populations. Notwithstanding high heterogeneity, pooled results from behavioural outcomes reflected a consistent, significant moderate effect in favour of better performance by healthy controls and, with the exception of one study, pooled results from physiological outcomes reflected no evidence for an effect. Future research would benefit from the use of clearly defined constructs of working memory, as well as standardised methods of testing.
Publisher: University of South Australia
Date: 2018
DOI: 10.25954/3H70-9Z07
Publisher: Oxford University Press (OUP)
Date: 03-2013
DOI: 10.2522/PTJ.20120263
Abstract: A treatment-based classification algorithm for low back pain (LBP) was created to help clinicians select treatments to which people are most likely to respond. To allow the algorithm to classify all people with LBP, additional criteria can help therapists make decisions for people who do not clearly fit into a subgroup (ie, unclear classifications). Recent studies indicated that classifications are unclear for approximately 34% of people with LBP. To guide improvements in the algorithm, it is imperative to determine whether people with unclear classifications are different from those with clear classifications. This study was a secondary analysis of data from 3 previous studies investigating the algorithm. Baseline data from 529 people who had LBP were used (3 discrete cohorts). The primary outcome was type of classification, that is, clear or unclear. Univariate logistic regression was used to determine which participant variables were related to having an unclear classification. People with unclear classifications had greater odds of being older (odds ratio [OR]=1.01, 95% confidence interval [CI]=1.003–1.033), having a longer duration of LBP (OR=1.001, 95% CI=1.000–1.001), having had a previous episode(s) of LBP (OR=1.61, 95% CI=1.04–2.49), having fewer fear-avoidance beliefs related to both work (OR=0.98, 95% CI=0.96–0.99) and physical activity (OR=0.98, 95% CI=0.96–0.996), and having less LBP-related disability (OR=0.98, 95% CI=0.96–0.99) than people with clear classifications. Studies from which participant data were drawn had different inclusion criteria and clinical settings. People with unclear classifications appeared to be less affected by LBP (less disability and fewer fear avoidance beliefs), despite typically having a longer duration of LBP. Future studies should investigate whether modifying the algorithm to exclude such people or provide them with different interventions improves outcomes.
Publisher: Informa UK Limited
Date: 30-03-2023
DOI: 10.1080/10749357.2022.2058294
Abstract: Noninvasive electrical stimulation (ES) could have therapeutic potential in stroke recovery. However, there is no comprehensive evaluation of adverse events. This study systematically searched the literature to document frequency and prevalence of adverse events. A secondary aim was to explore associations between adverse events and ES parameters or participant characteristics. Seventy-five studies were included. Adverse events were minor in nature. The most frequently reported adverse events were tingling (37.3% of papers), burning (18.7%), headaches (14.7%) and fatigue (14.7%). Cathodal stimulation was associated with greater frequency of itching (p = .02), intensities of 1-2 mA with increased tingling (p = .04) and discomfort (p = .03), and current density <0.4mA/cm2 with greater discomfort (p = .03). Tingling was the most prevalent adverse event (18.1% of participants), with prevalence data not differing between active and control conditions (all p ≥ 0.37). In idual participants were more likely to report adverse events with increasing current density (r = 0.99, p = .001). Two severe adverse events were noted (a seizure and percutaneous endoscopic gastrostomy placement). ES appears safe in people with stroke as reported adverse events were predominantly minor in nature. An adverse events questionnaire is proposed to enable a more comprehensive and nuanced analysis of the frequency and prevalence of adverse events.
Publisher: Wiley
Date: 26-09-2015
DOI: 10.1002/HBM.22643
Publisher: Informa UK Limited
Date: 11-06-2018
Publisher: PeerJ
Date: 23-05-2022
DOI: 10.7717/PEERJ.13383
Abstract: Bodily state is theorised to play a role in perceptual scaling of the environment, whereby low bodily capacity shifts visuospatial perception, with distances appearing farther and hills steeper, and the opposite seen for high bodily capacity. This may play a protective role, where perceptual scaling discourages engaging with the environment when capacity is low. Our protocol was pre-registered via Open Science Framework ( osf.io/6zya5/ ) with all amendments to the protocol tracked. We performed a systematic review and meta-analysis examining the role of bodily state/capacity on spatial perception measures of the environment. Databases (Medline, PsychINFO, Scopus, Embase, and Emcare) and grey literature were searched systematically, inclusive to 26/8/21. All studies were assessed using a customised Risk of Bias form. Standard mean differences and 95% CIs were calculated via meta-analysis using a random-effects model. A total of 8,034 studies were identified from the systematic search. Of these, 68 experiments (3,195 participants) met eligibility and were included in the review. These were grouped into the following categories: fatigue pain age embodiment body size/body paty size glucose levels fitness and interoception, and interoceptive accuracy. We found low level evidence (limited studies, high risk of bias) for the effect of bodily state on spatial perception. There was consistent evidence that both glucose manipulations and age influence spatial perception of distances and hills in a hypothesised direction (lower capacity associated with increased distance and hill steepness). Mixed evidence exists for the influence of external loads, embodiment, body/body-part size manipulations, pain, and interoceptive accuracy. Evidence for fitness and/or fatigue influencing spatial perception was conflicting notably, methodological flaws with fitness and fatigue paradigms and heterogenous spatial perception measures may underlie null/conflicting results. We found limited evidence for bodily state influencing spatial perception of the environment. That all studies had high risk of bias makes conclusions about reported effects reflecting actual perceptual shifts ( vs merely reflecting experimental demands or error due to inadequate study design) pre-emptive. Rigorous evaluation is needed to determine whether reported effects reflect more than bias ( e.g ., experimental demands, inadequate blinding). Future work using reliable measures of spatial perception, comprehensive evaluation of relevant confounders, and methodologically robust (and experimentally confirmed) bodily state experimental paradigms is warranted.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2008
Publisher: PeerJ
Date: 04-10-2023
DOI: 10.7717/PEERJ.16095
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.MSKSP.2018.07.002
Abstract: This proof-of-concept pilot study aimed to investigate if a visual illusion that altered the size and muscularity of the back could be embodied and alter perception of the back. The back visual illusions were created using the MIRAGE multisensory illusion system. Participants watched real-time footage of a modified version of their own back from behind. Participants undertook one experimental condition, in which the image portrayed a muscled, fit-looking back (Strong), and two control conditions (Reshaped and Normal) during a lifting task. Embodiment, back perception as well as pain intensity and beliefs about the back during lifting were assessed. Two participants with low back pain were recruited for this study: one with altered body perception and negative back beliefs (Participant A) and one with normal perception and beliefs (Participant B). Participant A embodied the Strong condition and pain and fear were less and both perceived strength and confidence were more than for the Normal or the Reshaped condition. Participant B did not embody the Strong condition and reported similar levels of pain, fear strength and confidence across all three conditions. An illusion that makes the back look strong successfully induced embodiment of a visually modified back during a lifting task in a low back pain patient with altered body perception. Both participants tolerated the illusion, there were no adverse effects, and we gained preliminary evidence that the approach may have therapeutic potential.
Publisher: PeerJ
Date: 17-07-2018
DOI: 10.7717/PEERJ.5206
Abstract: Experimental and clinical evidence support a link between body representations and pain. This proof-of-concept study in people with painful knee osteoarthritis (OA) aimed to determine if: (i) visuotactile illusions that manipulate perceived knee size are analgesic (ii) cumulative analgesic effects occur with sustained or repeated illusions. Participants with knee OA underwent eight conditions (order randomised): stretch and shrink visuotactile (congruent) illusions and corresponding visual, tactile and incongruent control conditions. Knee pain intensity (0–100 numerical rating scale 0 = no pain at all and 100 = worst pain imaginable) was assessed pre- and post-condition. Condition (visuotactile illusion vs control) × Time (pre- ost-condition) repeated measure ANOVAs evaluated the effect on pain. In each participant, the most beneficial illusion was sustained for 3 min and was repeated 10 times (each during two sessions) paired t -tests compared pain at time 0 and 180s (sustained) and between illusion 1 and illusion 10 (repeated). Visuotactile illusions decreased pain by an average of 7.8 points (95% CI [2.0–13.5]) which corresponds to a 25% reduction in pain, but the tactile only and visual only control conditions did not (Condition × Time interaction: p = 0.028). Visuotactile illusions did not differ from incongruent control conditions where the same visual manipulation occurred, but did differ when only the same tactile input was applied. Sustained illusions prolonged analgesia, but did not increase it. Repeated illusions increased the analgesic effect with an average pain decrease of 20 points (95% CI [6.9–33.1])–corresponding to a 40% pain reduction. Visuotactile illusions are analgesic in people with knee OA. Our results suggest that visual input plays a critical role in pain relief, but that analgesia requires multisensory input. That visual and tactile input is needed for analgesia, supports multisensory modulation processes as a possible explanatory mechanism. Further research exploring the neural underpinnings of these visuotactile illusions is needed. For potential clinical applications, future research using a greater dosage in larger s les is warranted.
Publisher: Public Library of Science (PLoS)
Date: 15-06-2016
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 07-2016
Abstract: Clinical prediction rules (CPRs) are created to help guide clinical decision making. To do this, they use the presence or absence of certain factors that have been shown to meaningfully predict a patient's prognosis, diagnosis, or response to treatment. While representing a seminal methodological step forward in in idualized care, one of the main drawbacks of CPRs continues to be validation studies that do not support the initially derived CPR. This is particularly important because validation of CPRs in an independent patient population prior to clinical implementation is essential. Why is it quite common for existing CPRs to fall down at the validation stage? And what does this mean for research that aims to in idualize treatment? J Orthop Sports Phys Ther 2016 (7):502-505. doi:10.2519/jospt.2016.0606.
Start Date: 2018
End Date: 2021
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2011
End Date: 2014
Funder: Canadian Institutes of Health Research
View Funded Activity